RAJASTHAN HIGH COURT, JODHPUR

Direct Recruitment to the Cadre of Civil Judge, 2021

Application Form
Application No: 608276 Token No.: 210384044636 Amount: 1000

1. Applicant Details
1.1 Applicant's Name SAMIKSHA AGARWAL
1.2 Father's Name SANJAY AGARWAL
1.3 Mother's Name RAJKUMARI AGARWAL
1.4 Bonafide Resident of RAJASTHAN
1.5 Home District JAIPUR
1.6 Category GENERAL 1.7 Gender FEMALE
1.8 Nationality CITIZEN OF INDIA 1.9 Marital Status UNMARRIED
On or Before 25/10/2010 After 25/10/2010 Total
1.10 No. of Children Born
0 0 0
1.11 City of Examination JAIPUR
2. Special Categories
2.1 Person With Disabilities No
-
2.1.A Category of Disability
2.2 Employee of Rajasthan Govt./Panchayat Samities/Zila Parishads/PSUs/Corporations No
3. Date of Birth & Age
3.1 Date of Birth 30-05-1997 3.2 Age (As on 01-01-2022) 24 years, 7 months, 2 days.
4. Address Details
4.1 Address 8-F-1, SHRI SHYAM EXCELLENCY, SANTOSH NAGAR, GOPALPURA BY PASS
4.2 City/Village JAIPUR 4.3 District JAIPUR
4.4 Pincode 302019 4.5 State/U.T. RAJASTHAN
4.6 Phone No. 9660347083 4.7 Mobile No. 9660347083 4.8 Email-ID samikshaagarwal40@gmail.com
5. Educational Qualifications
Name of Examination Board / University / Institution Year Div./ Grade
5.1 Secondary CBSE 2013 1st
5.2 Sr. Sec./ Hr. Sec. CBSE 2015 1st
5.3 Graduation - - -
5.4 Bachelor of Law (Prof.) SYMBIOSIS LAW SCHOOL, PUNE 2021 1st
5.5 PG / Equivalent - - -
6. Other Information
6.1 Do you have more than one spouse living? No
6.2 Have you accepted Dowry in your marriage? No
6.3 Whether any charge sheet for committing any Offence has ever been filed against you in the Court of Law? No
6.4 Whether any negative final report concerning you has ever been filed in a Court of Law? No
6.5 Have you ever been convicted for any offence involving moral turpitude by a Court of Law? No
6.6 Have you ever been convicted for any offence other than involving moral turpitude by a Court of Law? No
6.7 Have you ever been acquitted for any offence involving moral turpitude or any offence by a Court of Law? No
6.8 Whether any criminal prosecution is pending against you? No
6.9 Whether Dismissed/Removed/Terminated from service by the previous Employer? No
6.10 Being an Advocate were you ever found guilty of professional misconduct? No
6.11 Have you been permanently debarred or disqualified from appearing in any examination? No
7. Declaration
I have Carefully read the terms and conditions of Advertisement, instructions and relevant rules before filling online application
and I hereby undertake to abide by them, particularly conditions of eligibility prescribed for recruitment.
I hereby declare and verify that all informations made in this online application are true, complete and correct. In the event of
any information being found false or incorrect or the ineligibility being detected, action as deemed fit, can be taken against me by the
High Court at any stage. I further declare & verify that I fulfill all the conditions of eligibility regarding age, educational qualification,
experience, fitness, character etc. prescribed for admission to the Examination/Interview. I also declare that I shall not directly or
indirectly influence the selection process in any manner.
I agree that the decision of Competent Committee, regarding eligibility or otherwise of the candidature, for admission to the
examination shall be final. Application incomplete in any respect may be rejected without any information to me.

Signature
Place JAIPUR Date 04-08-2021